An Unfinished Letter

On August 23rd of last year, one week before Katrina, I started a letter to the CEO of Aetna (my insurer through my employer). I’m preoccupied with other matters now, so I doubt I’ll ever complete this letter, much less send it.

An open letter to Dr. John W. Rowe, Chief Executive Officer of Aetna Inc.

Dear Dr. Rowe,

I got a packet from Aetna yesterday containing four booklets, well over a hundred pages altogether. The cover letter stated this was my “Aetna Summary Benefit Description,” and advised me to “read this document carefully and keep it in a safe place.”

Let me get straight to the point: I don’t have time to read 120 pages just to understand my health care plan. Neither do most people. It’s outrageous to ask people to cope with this much information.

I don’t have time to read this much information, but I thought I’d at least give it a shot. I opened up the first booklet. On the very first page, I saw a paragraph labelled “NOTICE.” The pragraph, in all capitals and bold type, read as follows:

YOUR SHARE OF THE PAYMENT FOR HEALTH CARE SERVICES MAY BE BASED ON THE AGREEMENT BETWEEN YOUR HEALTH PLAN AND YOUR PROVIDER. UNDER CERTAIN CIRCUMSTANCES, THIS AGREEMENT MAY ALLOW YOUR PROVIDER TO BILL YOU FOR AMOUNTS UP TO THE PROVIDER’S REGULAR BILLED CHARGES.

I didn’t understand what this meant the first time I read it, so I read it again. Then I read it a third time. Still I was perplexed.

But I noted the cover letter also said that if I had any questions, I could call Member Services. So I did. And they had no idea what I was talking about. Turns out they don’t even have a copy of these booklets on hand. Isn’t that something?

at least aetna hasn’t dropped you, or something completely ridiculous like that.
but you’re human, and not property in a high-risk flood zone.
health insurance, it seems, is getting more pointless on a daily basis.

It’s a good thing you didn’t waste your time and postage. This is what would have taken place:
1) Letter received and opened by one of many “administrative assistants”
2) Letter forwarded to Customer Relations Dept and assigned to a service
rep who knows about as much as the one you called.
3) Service rep will send a reply which will amout to a load of “mumbo jumbo”

You will then find yourself wondering why you bothered in the first place.

Only, as an employee benefits attorney, I spend my days answering questions from the employers and insurers, who are usually just as befuddled about how to interpret various benefits language.

I’ve been working in this area for nearly four years now, and I still never cease to be amazed at the incredible complexity that accompanies it. Employers spend thousands and thousands of dollars a year just to make sure they are following all of the legal rules.